Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume

OBJECTIVESurgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers.METHODSThe authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases.RESULTSOver the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly.CONCLUSIONSPartnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.

Download Full-text

Surgically treatable adult epilepsy: a changing patient population. Experience from a level 4 epilepsy center

Journal of Neurosurgery ◽

10.3171/2020.10.jns201629 ◽

2021 ◽

pp. 1-6

Author(s):

Jacob R. Lepard ◽

Esther Dupépé ◽

Matthew Davis ◽

Jennifer DeWolfe ◽

Bonita Agee ◽

...

Keyword(s):

Epilepsy Surgery ◽

Patient Population ◽

Group Versus ◽

Patient Characteristics ◽

Seizure Freedom ◽

Invasive Monitoring ◽

Patient Demographics ◽

Significant Difference ◽

Before And After ◽

Eloquent Cortex

OBJECTIVE Invasive monitoring has long been utilized in the evaluation of patients for epilepsy surgery, providing localizing information to guide resection. Stereoelectroencephalography (SEEG) was introduced at the authors’ level 4 epilepsy surgery program in 2013, with responsive neurostimulation (RNS) becoming available the following year. The authors sought to characterize patient demographics and epilepsy-related variables before and after SEEG introduction to understand whether differences emerged in their patient population. This information will be useful in understanding how SEEG, possibly in conjunction with RNS availability, may have changed practice patterns over time. METHODS This is a retrospective cohort study of consecutive patients who underwent surgery for epilepsy from 2006 to 2018, comprising 7 years before and 5 years after the introduction of SEEG. The authors performed univariate analyses of patient characteristics and outcomes and used generalized estimating equations logistic regression for predictive analysis. RESULTS A total of 178 patients were analyzed, with 109 patients in the pre-SEEG cohort and 69 patients in the post-SEEG cohort. In the post-SEEG cohort, more patients underwent invasive monitoring for suspected bilateral seizure onsets (40.6% vs 22.0%, p = 0.01) and extratemporal seizure onsets (68.1% vs 8.3%, p < 0.0001). The post-SEEG cohort had a higher proportion of patients with seizures arising from eloquent cortex (14.5% vs 0.9%, p < 0.001). Twelve patients underwent RNS insertion in the post-SEEG group versus none in the pre-SEEG group. Fewer patients underwent resection in the post-SEEG group (55.1% vs 96.3%, p < 0.0001), but there was no significant difference in rates of seizure freedom between cohorts for those patients having undergone a follow-up resection (53.1% vs 59.8%, p = 0.44). CONCLUSIONS These findings demonstrate that more patients with suspected bilateral, eloquent, or extratemporal epilepsy underwent invasive monitoring after adoption of SEEG. This shift occurred coincident with the adoption of RNS, both of which likely contributed to increased patient complexity. The authors conclude that their practice now considers invasive monitoring for patients who likely would not previously have been candidates for surgical investigation and subsequent intervention.

Download Full-text

Effects of a Newly Developed Therapeutic Deep Heating Device Using High Frequency in Patients with Shoulder Pain and Disability: A Pilot Study

Pain Research and Management ◽

10.1155/2019/8215371 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Gi-Wook Kim ◽

Yu Hui Won ◽

Sung-Hee Park ◽

Jeong-Hwan Seo ◽

Dae-hyun Kim ◽

...

Keyword(s):

Los Angeles ◽

Shoulder Pain ◽

High Frequency ◽

Constant Score ◽

Frequency Wave ◽

Heating Device ◽

Significant Difference ◽

Before And After ◽

And Function ◽

The University

Objectives. The newly developed therapeutic deep heating device can generate deep heat in focal tissue using high-frequency wave stimulation. The objective of this study was to evaluate and compare the effectiveness of this deep heating device (HIPER-500®) with ultrasound in alleviating pain and improving function in patients with shoulder disability. Methods. This noninferiority trial was designed to compare the treatment effect of HIPER-500® to that of SonoStim® (ultrasound) on shoulder pain and disability. Thirty-eight patients with shoulder problems were assigned to either the HIPER-500® or SonoStim® group, and each participated in 10 min therapy sessions, five days a week for two weeks (for a total of ten sessions). Shoulder pain and disability were evaluated using the Visual Analogue Scale (VAS), the University of California at Los Angeles score (UCLA score), the Shoulder Pain and Disability Index (SPADI), and the Constant score in both groups before, immediately after, and four weeks after treatment. Statistical analysis was performed to compare the effects of treatment within and between the groups. Results. A total of 34 patients completed the study. The 18 patients in the HIPER-500® group and 16 patients in the SonoStim® group all showed significant improvements in shoulder pain and function when comparing pretreatment values with the results immediately after treatment and four weeks later. The results before and after treatment did not show a statistically significant difference between the two groups. Conclusions. The newly developed HIPER-500® for high-frequency deep heat therapy showed similar effects to those of SonoStim® for relieving pain and improving physical performance in the patients of this study. HIPER-500® may be a useful modality for treating shoulder pain and improving physical activity in patients with shoulder disease.

Download Full-text

Low back pain: Differential diagnosis, prognosis and treatment

Acta chirurgica iugoslavica ◽

10.2298/aci0604049l ◽

2006 ◽

Vol 53 (4) ◽

pp. 49-52

Author(s):

V. Lalosevic ◽

Z. Poleksic ◽

Z. Blagojevic ◽

S. Tomic ◽

S. Milickovic

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Orthopedic Surgery ◽

Surgical Care ◽

Blood Analysis ◽

Low Back ◽

Visual Analog Scales ◽

Significant Difference ◽

Before And After ◽

Treatment Data

From January 2002 to February 2003, 137 patients complaining of low back pain were treated at the Institute for Orthopedic Surgery "Banjica", Belgrade, Serbia. There were 89 male and 48 female patients aged 13 to 77, mean age 42.2. Their condition was diagnosed through use of radiography, CT, MRI, EMNG, standard battery of neurological tests, and laboratory analyses (urine and blood analysis). Surgical treatment was performed on 39 patients; all other patients received some form of non-surgical care (physical therapy, medication or corset). Treatment efficacy was evaluated by use of the visual analog scales (VAS) and the Oswestry index, before and after treatment. The use Wilcoxon?s pair test revealed statistically significant difference between before and after treatment data on VAS and Oswestry index for all patients.

Download Full-text

Cognitive performance in distinct groups of children undergoing epilepsy surgery—a single-centre experience

PeerJ ◽

10.7717/peerj.7790 ◽

2019 ◽

Vol 7 ◽

pp. e7790

Author(s):

Barbora Benova ◽

Anezka Belohlavkova ◽

Petr Jezdik ◽

Alena Jahodová ◽

Martin Kudr ◽

...

Keyword(s):

Cognitive Performance ◽

Epilepsy Surgery ◽

Cognitive Outcomes ◽

Tertiary Centre ◽

Large Patient ◽

Significant Difference ◽

Before And After ◽

Individual Variables ◽

One Year ◽

Paediatric Epilepsy

Background We aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical). Methods We analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change. Results Epilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model. Discussion Post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.

Download Full-text

Freedom From Seizures Might Be Key to Continuing Occupation After Epilepsy Surgery

Frontiers in Neurology ◽

10.3389/fneur.2021.585191 ◽

2021 ◽

Vol 12 ◽

Author(s):

Toshiki Nozaki ◽

Ayataka Fujimoto ◽

Tomohiro Yamazoe ◽

Keiko Niimi ◽

Shimpei Baba ◽

...

Keyword(s):

Epilepsy Surgery ◽

Employment Status ◽

Secondary Outcome ◽

Rank Test ◽

Seizure Freedom ◽

Adult Intelligence Scale ◽

Neuropsychological Status ◽

Significant Difference ◽

Before And After ◽

Level 2

Introduction: We hypothesized that epilepsy surgery for adult patients with temporal lobe epilepsy (TLE) who obtained freedom from seizures could provide opportunities for these patients to continue their occupation, and investigated continuity of occupation to test this postulation.Methods: Data were obtained from patients who had undergone resective surgery for medically intractable TLE between October 2009 and April 2019 in our hospital. Inclusion criteria were as follows: (1) ≥16 years old at surgery; (2) post-operative follow-up ≥12 months; (3) seizure-free period ≥12 months. As a primary outcome, we evaluated employment status before and after surgery, classified into three categories as follows: Level 0, no job; Level 1, students or homemakers (financially supported by a family member); and Level 2, working. Neuropsychological status was also evaluated as a secondary outcome.Results: Fifty-one (87.9%) of the 58 enrolled TLE patients who obtained freedom from seizures after surgery continued working as before or obtained a new job (employment status: Level 2). A significant difference in employment status was identified between before and after surgery (p = 0.007; Wilcoxon signed-rank test). Twenty-eight patients (48.3%) were evaluated for neuropsychological status both before and after surgery. Significant differences in Wechsler Adult Intelligence Scale-III scores were identified between before and after surgery (p < 0.05 each; paired t-test).Conclusion: Seizure freedom could be a factor that facilitates job continuity, although additional data are needed to confirm that possibility. Further investigation of job continuity after epilepsy surgery warrants an international, multicenter study.

Download Full-text

Multimodal localization and surgery for epileptic spasms of focal origin: a review

Neurosurgical FOCUS ◽

10.3171/2018.6.focus18217 ◽

2018 ◽

Vol 45 (3) ◽

pp. E4 ◽

Cited By ~ 7

Author(s):

Taylor J. Abel ◽

Emma Losito ◽

George M. Ibrahim ◽

Eishi Asano ◽

James T. Rutka

Keyword(s):

Epilepsy Surgery ◽

Focal Epilepsy ◽

Intractable Epilepsy ◽

Epileptogenic Zone ◽

Invasive Monitoring ◽

Current State ◽

Epileptic Spasms ◽

Clinical Series ◽

Postoperative Seizure ◽

Monitoring Technologies

Epileptic spasms (ES) are a common manifestation of intractable epilepsy in early life and can lead to devastating neurodevelopmental consequences. Epilepsy surgery for ES is challenging because of inherent difficulties in localizing the epileptogenic zone in affected infants and children. However, recent clinical series of resective neurosurgery for ES suggest that not only is surgery a viable option for appropriately selected patients, but postoperative seizure outcomes can be similar to those achieved in other types of focal epilepsy. Increased awareness of ES as a potentially focal epilepsy, along with advances in neuroimaging and invasive monitoring technologies, have led to the ability to surgically treat many patients with ES who were previously not considered surgical candidates. In this study, the authors review the current state of epilepsy surgery for ES. Specifically, they address how advances in neuroimaging and invasive monitoring have facilitated patient selection, presurgical evaluation, and ultimately, resection planning.

Download Full-text

Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02413-4 ◽

2021 ◽

Author(s):

U Krafft ◽

O Mahmoud ◽

J Hess ◽

J.P Radtke ◽

A Panic ◽

...

Keyword(s):

Renal Function ◽

Urinary Diversion ◽

Surgical Care ◽

University Hospital ◽

Stricture Formation ◽

Significant Difference ◽

The Individual ◽

The University ◽

Anastomotic Techniques

Abstract Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.

Download Full-text

The Effectiveness of the Rule of Twenty Method in Reducing the Musculoskeletal Complaints among Educational Staffs

Jurnal Ergonomi Indonesia (The Indonesian Journal of Ergonomic) ◽

10.24843/jei.2020.v06.i02.p01 ◽

2020 ◽

Vol 6 (2) ◽

pp. 78

Author(s):

Ratih Andhika Akbar Rahma ◽

Dian Afif Arifah ◽

Ario Ramadhan

Keyword(s):

Musculoskeletal Disorders ◽

T Test ◽

Risk Level ◽

Musculoskeletal Complaints ◽

Significant Difference ◽

Before And After ◽

Post Test ◽

Educational Staff ◽

The University ◽

Paired T Test

Educational staff at the University of Darussalam Gontor sit in front of the computer screen for quite a long time, causing musculoskeletal complaints. Applying the Rule of Twenty (RoT) method is one way to minimize the risk of musculoskeletal disorders. This study aimed to measure the effectiveness of the Rule of Twenty methods in reducing the risk level of complaints of musculoskeletal disorders for the educational staff of the University of Darussalam Gontor. This study was a pre-experimental research with one group pre-test – post-test design. The population in this study was the entire 68 educational staff of the University of Darussalam Gontor. Twenty-one (21) staff involved as a sample in this study and selected by purposive sampling method. The Nordic Body Map instrument was used to measure musculoskeletal complaint levels before and after the rule of twenty methods applied. Data were analyzed using the SPSS program version with autocorrelation test and paired t-test (CI: 95%). The measurement results of musculoskeletal disorders among 21 respondents before and after the application of RoT were the level of action 1 (low-risk level). The result of the autocorrelation measurement showed that the value of Durbin Watson (DW) was 1.958 and DW (1.968)> DU (1.8116), indicates that there was no autocorrelation between variables. The paired t-test showed the value of t = 5.760 and p = 0.0001, indicates a significant difference between musculoskeletal disorders before and after the application of the Rule of Twenty Method (p<0.05). Based on the result, this study found that the Rule of Twenty Method is effective in reducing the musculoskeletal disorders of the Educational Staffs, and potentially reduce 9.4% of musculoskeletal complaints among workers.

Download Full-text

Functional Connectivity of the Anterior Nucleus of the Thalamus in Pediatric Focal Epilepsy

Frontiers in Neurology ◽

10.3389/fneur.2021.670881 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rory J. Piper ◽

Chayanin Tangwiriyasakul ◽

Elhum A. Shamshiri ◽

Maria Centeno ◽

Xiaosong He ◽

...

Keyword(s):

Functional Connectivity ◽

Focal Epilepsy ◽

Epileptiform Activity ◽

Epileptogenic Zone ◽

Healthy Children ◽

Anterior Nucleus ◽

Epileptiform Discharges ◽

Significant Difference ◽

Before And After ◽

Drug Resistant Epilepsy

Objective: Whilst stimulation of the anterior nucleus of the thalamus has shown efficacy for reducing seizure frequency in adults, alterations in thalamic connectivity have not been explored in children. We tested the hypotheses that (a) the anterior thalamus has increased functional connectivity in children with focal epilepsy, and (b) this alteration in the connectome is a persistent effect of the disease rather than due to transient epileptiform activity.Methods: Data from 35 children (7–18 years) with focal, drug-resistant epilepsy and 20 healthy children (7–17 years) were analyzed. All subjects underwent functional magnetic resonance imaging (fMRI) whilst resting and were simultaneously monitored with scalp electroencephalography (EEG). The fMRI timeseries were extracted for each Automated Anatomical Labeling brain region and thalamic subregion. Graph theory metrics [degree (DC) and eigenvector (EC) centrality] were used to summarize the connectivity profile of the ipsilateral thalamus, and its thalamic parcellations. The effect of interictal epileptiform discharges (IEDs) captured on EEG was used to determine their effect on DC and EC.Results: DC was significantly higher in the anterior nucleus (p = 0.04) of the thalamus ipsilateral to the epileptogenic zone in children with epilepsy compared to controls. On exploratory analyses, we similarly found a higher DC in the lateral dorsal nucleus (p = 0.02), but not any other thalamic subregion. No differences in EC measures were found between patients and controls. We did not find any significant difference in DC or EC in any thalamic subregion when comparing the results of children with epilepsy before, and after the removal of the effects of IEDs.Conclusions: Our data suggest that the anterior and lateral dorsal nuclei of the thalamus are more highly functionally connected in children with poorly controlled focal epilepsy. We did not detect a convincing change in thalamic connectivity caused by transient epileptiform activity, suggesting that it represents a persistent alteration to network dynamics.

Download Full-text

A experiência clínica influencia na capacidade de alunos para o diagnóstico de alterações dentoalveolares utilizando exames radiográficos intraorais?

Revista da Faculdade de Odontologia de Porto Alegre ◽

10.22456/2177-0018.101545 ◽

2020 ◽

Vol 61 (2) ◽

pp. 7-12

Author(s):

Eduarda Adams Hilgert ◽

Heraldo Luis Dias da Silveira ◽

Mariana Boessio Vizzotto ◽

Priscila Fernanda Da Silveira Tiecher ◽

Nádia Assein Arús

Keyword(s):

Undergraduate Students ◽

Clinical Training ◽

Correct Diagnosis ◽

Educational Strategies ◽

Radiographic Images ◽

Significant Difference ◽

Before And After ◽

School Of Dentistry ◽

South Of Brazil ◽

The University

Mastery of interpretation of radiographic images is a contributing factor in correct diagnosis of conditions affecting the dentoalveolar apparatus. It is therefore essential that students’ perfect these skills while studying for their degrees. Once they embark upon their professional careers outside of the university setting, it is expected that the theoretical knowledge and clinical experience accumulated during the course of their studies will have led to improved diagnostic performance. Objective: The objective of this study was to evaluate diagnoses made using intraoral radiographs by undergraduate students at a School of Dentistry in the South of Brazil, before and after their introduction to clinical practice. Materials and methods: Diagnoses made during the second (T0) and fourth (T1) years of the undergraduate course in dentistry using interproximal and periapical radiographs were analyzed. Descriptive statistics were calculated and the McNemar test was used to compare answers at T0 and T1. Results: Fifteen students answered questionnaires at both T0 and T1. The overall percentage of correct answers was 70.5% at T0 and 61.6% at T1, with a significant difference (p = 0.024). Discussion: This study highlights the need for educational strategies that improve diagnostic competence during undergraduate clinical activities, since radiographic examinations are essential in all areas of dentistry. Conclusions: Therefore, it was concluded that the rate of correct diagnosis of dentoalveolar disorders by intraoral radiography decreased significantly after the initial years of clinical training.

Download Full-text